Emily Sallee and I had an excellent (and inspiring) day 1 at the 2022 MASP Summer Institute. The MASP members and other participants have been fabulous. Today, we built a foundation upon which we will build great things tomorrow.
What’s up for tomorrow? Advanced treatment planning using the seven-dimensional strengths-based model. Just in case you’re at the Summer Institute OR you want a peek into what we’re doing, here are some handouts.
Here’s a visual/cartoon with a nice message, despite the outdated language.
And here’s some late-breaking news related to Montana Schools.
Next Monday and Tuesday (June 6 and 7), in Billings, I’m partnering with the amazing Dr. Emily Sallee to offer a two-day workshop for the Montana Association of School Psychologists. This is an in-person workshop—which is pretty darn exciting, especially because COVID cases in Billings right now are low.
The workshop is titled,Weaving Evidence-Based Happiness Interventions into Suicide Assessment & Treatment Planning .
Here’s the description:
In this 2-day workshop you will build your skills for providing evidence-based suicide assessment and treatment. Using a strengths-based foundation, this workshop includes a critique of traditional suicide assessment, a review of an alternative assessment approach for determining “happiness potential,” and skill-building activities on how to use more nuanced and therapeutic approaches to assessment. We will view video clips and engage in active practice of strategies for building hope from the bottom up, safety-planning and other essential interventions. Throughout the workshop, we will explore how to integrate evidence-based happiness and wellness strategies into suicide assessment, treatment, and professional self-care.
As a part of my presentations for ACA last week, I prepared a couple of short video clips. These clips are part of a much, much longer, three-volume (7.5 hour) video series produced and published by psychotherapy.net. Victor Yalom of psychotherapy.net gave me permission to occasionally share a few short clips like these. If you’re interested in purchasing the whole video series (or having your library do so), you can check out the series here: https://www.psychotherapy.net/videos/expert/john-sommers-flanagan
IMHO, although the whole video series is excellent and obviously I recommend it, these clips can be used all by themselves to stimulate class discussions. Check them out if you’re interested.
Kennedy is a 15-year-old cisgender female referred by her parents for suicidal ideation. Although a case could be made for using a family systems approach, this opening is of me working 1-1 with Kennedy. When I show this video, I like to emphasize that I’m using a “Strengths-based Approach” AND I’m also asking a series of questions that pull for Kennedy to talk about her distress. This is because clients generally need to talk about their distress before they can focus on strengths or solutions. Instead of practicing “toxic positivity” this approach emphasizes the need to come alongside and be empathic with client pain and distress.
Chase is a 35-year-old cisgender Gay male. In this brief excerpt, I try (somewhat poorly) to use a pattern interpretation to facilitate insight into his history of social relationships. Chase’s response is to dismiss my interpretation. Back in my psychoanalytic days, we talked about and used trial interpretations to gauge whether an abstract-oriented psychodynamic approach was a good fit for clients. Chase’s response is so dismissive that I immediately shift to using a very concrete approach to analyzing his social universe. Then, when Chase isn’t able to identify anyone who is validating, I use a strategy I call “Building hope from the bottom up” to help him start the brainstorming process.
A big thanks to psychotherapy.net and Victor Yalom for their support of this work.
As always, if you have thoughts or feedback on these clips or life in general, please feel free to share.
Last week I had the honor of presenting three times at the American Counseling Association meeting in Atlanta. Today, I’m posting the Abstracts and Powerpoints from those presentations, just in case someone might find the information useful.
On Friday, April 8: The way of the humanist: Illuminating the path from suicide to wellness. Invited presentation on behalf of the Association for Humanistic Counseling.
At this moment, counselors are hearing more distress, anxiety, and suicidal ideation than ever before. In response, we are called to resonate with our clients’ distress. On behalf of the Association for Humanistic Counseling, John Sommers-Flanagan will describe how humanistic principles of acceptance and empathy can paradoxically prepare clients to embrace wellness interventions. Participants will learn five evidence-based happiness strategies to use with their clients and with themselves.
Also, on Friday, April 8: Using a strengths-based approach to suicide assessment and treatment in your counseling practice. Invited presentation on behalf of ACA Publications.
Most counselors agree: no clinical task is more stressful than suicide assessment and treatment planning. When working with people who are suicidal, it’s all-too-easy for counselors to over-focus on psychopathology and experience feelings of hopelessness and helplessness. However, framing suicidal ideation as an unparalleled opportunity to help alleviate your client’s deep psychological pain, and embracing a strengths-based orientation, you can relieve some of your own anxiety. This practice-oriented education session includes an overview of strengths-based principles for suicide assessment and treatment.
On Saturday, April 9, Being seen, being heard: Strategies for working with adolescents in the age of Tik Tok. Educational presentation (with Chinwe Williams).
Counseling and connecting with adolescents can be difficult. In this educational session, we will present six strategies for connecting with and facilitating change among adolescents. For each strategy, the co‐presenters, coming from different cultural and generational perspectives, will engage each other and participants in a discussion of challenges likely to emerge when counseling adolescents. Social media influences, self‐disclosure, and handling adolescents’ questions will be emphasized.
Today I’m spending all day with the Youth Homes staff in Missoula . . . talking about strengths-based approaches to suicide. Should be fun, or at least as fun as a day of talking about suicide can be . . . Happy Friday, and here are the ppts!
Back in the days when video recording involved film rather than digits, editors would talk about leaving excellent footage “on the floor.” How do I know this? I was alive back in the day.
Today I’ve been working on revising a continuing education “course” for ContinuingEdCourses.net. The course has been popular and so the ContinuingEdCourses.net owners asked for a revision. I stalled until they recognized my stalling for what it was essentially told me I was overdue and late, which made me decide it would feel better to finish the revision than it would to keep procrastinating. I’m guessing maybe others of you out there can relate to that particular moment in time.
While editing and revising I discovered (actually I rediscovered) my penchant for redundancy. Sometimes that penchant is intentional and other times the penchant is an annoying rediscovery. This paragraph that you’re reading in the here-and-now includes an intentional penchant. The CE course included an unintentional penchant. Are you familiar with the research on the overuse of words? If you repeat a word over and over, after only a few seconds you can become desensitized to the meaning of the word and the word will just sound like a sound. I’m feeling a penchant for that too.
Bottom line: I had to cut some nice content. It ended up on the metaphorical floor, until I picked it up, dusted it off, and put it in this blog. Here you go. . .
Editor’s note [BTW, I’m the editor here, because it’s my blog, so I own all the mistakes, misspellings, and misplaced commas]: Turns out I edited out the other redundant content, but I’m posting this anyway, because it’s still 2/22/22, which happens to be most redundant date of the year. Now, here you go. . .
Four Suicide Myths
The word “myth” has two primary meanings.:
A myth is a traditional or popular story or legend used to explain current cultural beliefs and practices. This definition emphasizes the positive guidance that myths sometimes provide. For example, the Greek myth of Narcissus warns that excessive preoccupation with one’s own beauty can become dangerous. Whether or not someone named Narcissus ever existed is irrelevant; the story tells us that too much self-love may lead to our own downfall.
The word myth is also used to describe an unfounded idea, or false notion. Typically, the false notion gets spread around and, over time, becomes a generally accepted, but inaccurate, popular belief. One contemporary example is the statement, “Lightning never strikes the same place twice.” In fact, lightning can and does strike the same place twice (or more). During an electrical storm, standing on a spot where lightning has already struck, doesn’t make for a good safety strategy.
The statement “We only use 10% of our brains” is another common myth. Although it’s likely that most of us can and should more fully engage our brains, scientific researchers (along with the Mythbusters television show) have shown that much more than 10% of our brains are active most of the time – and probably even when we’re sleeping.
False myths can stick around for much longer than they should; sometimes they stick around despite truckloads of contradictory evidence. As humans, we tend to like easy explanations, especially if we find them personally meaningful or affirming. Never mind if they’re accurate or true.
Historically, myths were passed from individuals to groups and other individuals via word of mouth. Later, print media was used to more efficiently communicate ideas, both factual and mythical. Today we have the internet and instant mythical messaging.
Suicide myths weren’t and aren’t designed to intentionally mislead; mostly (although there are some exceptions) they’re not about pushing a political agenda or selling specific products. Instead, suicide myths are the product of dedicated, well-intended people whose passion for suicide prevention sometimes outpaces their knowledge of suicide-related facts (Bryan, 2022).
Depending on your perspective, your experiences, and your knowledge base, it’s possible that my upcoming list of suicide myths will push your emotional buttons. Maybe you were taught that “suicide is 100% preventable.” Or, maybe you believe that suicidal thoughts or impulses are inherently signs of deviance or a mental disturbance. If so, as I argue against these myths, you might find yourself resisting my perspective. That’s perfectly fine. The ideas that I’m labeling as unhelpful myths have been floating around in the suicide prevention world for a long time; there’s likely emotional and motivational reasons for that. Also, I don’t expect you to immediately agree with everything in this document. However, I hope you’ll give me a chance to make the case against these myths, mostly because I believe that hanging onto them is unhelpful to suicide assessment and prevention efforts.
Myth #1: Suicidal thoughts are about death and dying.
Most people assume that suicidal thoughts are about death and dying. Someone has thoughts about death, therefore, the thoughts must literally be about death. But the truth isn’t always how it appears from the surface. The human brain is complex. Thoughts about death may not be about death itself.
Let’s look at a parallel example. Couples who come to counseling often have conflicts about money. One partner likes to spend, while the other is serious about saving. From the surface, you might mistakenly assume that when couples have conflicts about money, the conflicts are about money – dollars, cents, spending, and saving. However, romantic relationships are complex, which is why money conflicts are usually about other issues, like love, power, and control. Nearly always there are underlying dynamics bubbling around that fuel couples’ conflicts over money.
Truth #1: Among suicidologists and psychotherapists, the consensus is clear: suicidal thoughts and impulses are less about death and more about a natural human response to intense emotional and psychological distress (aka psychache or excruciating distress). I use the term “excruciating distress” to describe the intense emotional misery that nearly always accompanies the suicidal state of mind. The take-home message from busting this myth should help you feel relief when clients mention suicide. You can feel relief because when clients trust you enough to share their suicidal thoughts and excruciating distress with you, it gives you a chance to help and support them. In contrast, when clients don’t tell you about their suicidal thoughts, then you’re not able to provide them with the services they deserve. Your holding an attitude that welcomes client openness and their sharing of distress and suicidal thoughts is foundational to effective treatment.
Myth #2: Suicide and suicidal thinking are signs of mental illness.
Philosophers and research scientists agree: nearly everyone on the planet thinks about suicide at one time or another – even if briefly. The philosopher Friedrich Nietzsche referred to suicidal thoughts as a coping strategy, writing, “The thought of suicide is a great consolation: by means of it one gets through many a dark night.” Additionally, the rates of suicidal thinking among high school and college students is so high (estimates of 20%-40% annual incidence) that it’s more appropriate to label suicidal thoughts as common, rather than a sign of deviance or illness.
Edwin Shneidman – the American “Father” of suicidology – denied a relationship between suicide and so-called mental illness in the 1973 Encyclopedia Britannica, stating succinctly:
Suicide is not a disease (although there are those who think so); it is not, in the view of the most detached observers, an immorality (although … it has often been so treated in Western and other cultures).
A recent report from the U.S. Centers for Disease Control (CDC) supports Shneidman’s perspective. The CDC noted that 54% of individuals who died by suicide did not have a documented mental disorder (Stone et al., 2018). Keep in mind that the CDC wasn’t focusing on people who only think about or attempt suicide; their study focused only on individuals who completed suicide. If most individuals who die by suicide don’t have a mental disorder, it’s even more unlikely that people who think about suicide (but don’t act on their thoughts), suffer from a mental disorder. As Wollersheim (1974) used to say, “Having the thought of suicide is not dangerous and is not the problem (p. 223).”
Truth #2: Suicidal thoughts are not – in and of themselves – a sign of illness. Instead, suicidal thoughts arise naturally, especially during times of excruciating distress. The take-home message here is that clinicians should avoid judgment. I know that’s a tough message, because most of us are trained in diagnosing mental disorders and as we begin hearing of signs of depression, emotional lability, or other symptoms, it’s difficult not to begin thinking in terms of psychopathology. However, especially during initial encounters with clients who have suicidal ideation, it’s deeply important for us to avoid labeling – because if clients sense clinicians judging them, it can increase client shame and decrease the chances of them sharing openly.
Myth #3: Scientific knowledge about suicide risk factors and warning signs support accurate allows for the prediction and prevention of suicide.
As discussed previously, mMost suicidologists agree: that Ssuicide is extremelyvery difficult to predict (Franklin et al., 2017).
To get perspective on the magnitude of the problem, imagine you’re at the Neyland football stadium at the University of Tennessee. The stadium is filled with 100,000 fans. Your job is to figure out which 13.54 of the 100,000 fans will die by suicide over the next 365 days.
A good first step would be to ask everyone in the stadium the question that many suicide prevention specialists ask, “Have you been thinking about suicide?” Assuming the usual base rates and assuming that every one of theall 100,000 fans answer you honestly, you might rule out 85,000 people (because they say they haven’t been thinking about suicide). Then you ask them to leave the stadium. Now you’re down to identifying which 13.54 of 15,000 will die by suicide.
For your next step you decide to do a quick screen for the diagnosis of clinical depression. Let’s say you’re highly efficient, taking only 20 minutes to screen and diagnose each of the 15,000 remaining fans. Never mind that it would take 5,000 hours. The result: Only 50% of the 15,000 fans meet the diagnostic criteria for clinical depression.
At this point, you’ve reduced your population to 7,500 University of Tennessee fans, all of whom are depressed and thinking about suicide. How will you accurately identify the 13 or 14 fans who will die by suicide? Mostly, based on mathematics and statistics, you won’t. Every effort to do this in the past has failed. Your best bet might be to provide aggressive pharmacological or psychological treatment for the remaining 7,500 people. If you choose antidepressant medications, you might inadvertently make about 200-250 of your “patients” even more suicidal. If you use psychotherapy, the time you need for effective treatment will be substantial. Either way, many of the fans will refuse treatment, including some of those who will later die by suicide. Further, as the year goes by, you’ll discover that several of the 85,000 fans who denied having suicidal thoughts, and whom you immediately ruled out as low risk, will confound your efforts at prediction and die by suicide.
To gain a broader perspective, imagine there are 3,270 stadiums across the U.S., each with 100,000 people, and each with 13 or 14 individuals who will die by suicide over the next year. All this points to the enormity of the problem. Most professionals who try to predict and prevent suicide realize that, at best, they will help some of the people some of the time.
Truth #3: Although there’s always the chance that future research will enable us to predict suicide, decades of scientific research don’t support suicide as a predictable event. Even if you know all the salient suicide predictors and warning signs, in the vast majority of cases you won’t be able to efficiently predict or prevent suicide attempts or suicide deaths. The take-home message from busting this myth is this: Lower your expectations about accurately categorizing client risk. Most of the research suggests you’ll be wrong (Bryan, 2022; Large & Ryan, 2014). Instead, as you explore risk factors with clients, use your understanding of risk factors as a method for deepening your understanding of the individual client with whom you’re working.
Myth #4: Suicide prevention and intervention should focus on eliminating suicidal thoughts.
Logical analysis implies that if psychotherapists or prevention specialists can get people to stop thinking about suicide, then suicide should be prevented. Why then, do the most knowledgeable psychotherapists in the U.S. advise against directly targeting suicidal thoughts in psychotherapy (Linehan, 1993; Sommers-Flanagan & Shaw, 2017)? The first reason is because most people who think about suicide never make a suicide attempt; that means you’re treating a symptom that isn’t necessarily predictive of the problem. But that’s only the tip of the iceberg.
After his son died by suicide, Rick Warren, a famous pastor and author, created a YouTube video titled, “Rick Warren’s Message for Those Considering Suicide.” The video summary reads,
If you have ever struggled with depression or suicide, Pastor Rick has a message for you. The pain you are experiencing will not last forever. There is hope!
Although over 1,000 viewers clicked on the “thumbs up” sign for the video, there were 535 comments; nearly all of these comments pushed back on Pastor Warren’s well-intended video message. Examples included:
Are you kidding me??? You’ve clearly never been suicidal or really depressed.
To say “Suicide is a permanent solution to a temporary problem” is like saying: “You couldn’t possibly have suffered long enough, even if you’ve suffered your entire life from many, many issues.”
This is extremely disheartening. With all due respect. Pastor, you just don’t get it.
Pastor Rick isn’t alone in not getting it. Most of us don’t really get the excruciating distress, deep self-hatred, and chronic shame linked to suicidal thoughts and impulses. And because we don’t get it, sometimes we slip into try toing rationally persuadesion to encourage individuals with suicidal thoughts to regain hope and embrace life. Unfortunately, a nearly universal phenomenon called “psychological reactance” helps explain why rational persuasion – even when well-intended – rarely makes for an effective intervention (Brehm & Brehm, 1981).
While working with chronically suicidal patients for over two decades, Marsha Linehan of the University of Washington made an important discovery: when psychotherapists try to get their patients to stop thinking about suicide, the opposite usually happens – the patients become more suicidal.
Linehan’s discovery has played out in my clinical practice. Nearly every time I’ve actively pushed clients to stop thinking about suicide – using various psychological ploys and techniques – my efforts have backfired.
Truth #4: Most individuals who struggle with thoughts of suicide resist outside efforts to make them stop thinking about suicide. Using direct persuasion to convince people they should cheer up, have hope, and embrace life is rarely effective. The take-home message associated with busting this myth is that the best approaches to working with clients who are suicidal are collaborative. Instead of taking the role of an esteemed authority who knows what’s best for clients, effective counselors and psychotherapists take a step back and seek to activate their client’s expertise as collaborators onagainst the suicidal problem.
Apparently, video podcasts are the thing. Or maybe they’ve been a thing for a while. . . or at least since early 2020 and the onset of the Zoom age. I think we should call them vid-pods.
Two weeks ago, I promoted a vid-pod with Paula Fontenelle, Stacey Freedenthal, and me. It was Paula’s vid-pod, titled “Understand Suicide.” Paula is very experienced, very knowledgeable and produces great vid-pods. You can check out all her work, including her podcast (aka vid-pod) at: https://www.understandsuicide.com/
Late last year, Victor Yalom of Psychotherapy.net asked if he could connect me for a possible appearance on a vid-pod called “Normalize the Conversation.” Normalize the Conversation is the brain-child of Francesca Reicherter. Francesca is also the Founder and President of “Inspiring My Generation.” I think Victor wanted me to promote our 7.5-hour marathon Suicide Assessment and Treatment video training series with Psychotherapy.net. . . so here’s the link to that: https://www.psychotherapy.net/videos/expert/john-sommers-flanagan
Francesca and I did a recording together and she did a bunch of editing and promoting and this past week she sent me some video clips of our time together. What you’ll immediately notice in the video clips is that Francesca is an artist at getting people to talk. Throughout the clips, I’m talking and she’s not. Somehow, she got me to talk for about 47 minutes (although she did some nice summaries and commentary here and there). If my experience is at all representative, I suspect Francesca will be a talented therapist and fabulous listener.
You can check out the vid-pod clips below, but more importantly, check out all the amazing work of Paula, Stacey, Victor, and Francesca . . . all of whom are making the world a place where supportive and quality mental health services are more accessible.
While engaged in a little late-night Twitter scrolling, I came across a fascinating post and thread questioning the utility of suicide screening for low risk populations (e.g., schools). Having been mildly opposed (along with the UK and Canada), to general population suicide screenings, I felt validated, especially upon discovering that Craig Bryan was author of the Twitter thread. Dr. Bryan is one of the best and most authoritative resources on suicide in the world. As of two nights ago, I was only familiar with his professional book with David Rudd (Brief cognitive-behavior therapy for suicide prevention) and his excellent work with military veterans, suicide, and lethal means management. I also knew he had recently published a new book titled, “Rethinking Suicide.”
Then, today, I checked out Rethinking Suicide online. I was gob smacked. It’s fantastic.
This post is mostly to pitch Craig Bryan’s book.
Among other gems, Dr. Bryan frames suicide prevention as a “wicked problem” and tells us about the origin of the term, wicked problem. What’s not to love about that.
Here’s a quote from his introduction: “Consistent with the perspective of suicide as a wicked problem, I will argue in this book that we need to replace our solution-based approach to suicide prevention with a process-based approach focused on creating and building lives worth living” (p. 7). Wow. That’s like music to my ears.
Dr. Bryan also weaves in “confirmation bias” (more music) as part of his critique of using so-called “mental illness” as an explanatory mechanism in suicide (I know if you know me and this blog, you know I don’t even use the term mental illness unless I’m explaining why I don’t use the term mental illness, and so I’m destined to love Dr. Bryan’s deconstruction of that concept).
Anyway, you can find Rethinking Suicide through your favorite online bookseller. I recommend it highly. I’ve ordered my copy. It’s about time we all started rethinking suicide.
I’d like to invite you to join me at this year’s Psychotherapy Networker Symposium, where I’ll be speaking alongside over 60 of the world’s leading therapists and experts.
The Symposium is a special place where you not only learn with many of the best in the world and dive into what’s new in the field, but also where you can join a warm community of like-minded professionals to rest, rejuvenate, and be inspired for the year to come.
The Symposium is a pretty cool event and I’m honored to be presenting (twice). Although I can’t figure out why they didn’t include me among the keynoters (hahaha, just joking), the keynote lineup is very impressive.
I hope to see you there either in-person or online!
Last week I got to be part of an amazing conversation with Paula Fontenelle and Stacey Freedenthal. Paula and Stacey are experts in suicide prevention, postvention, and treatment. You can easily find them and some of their great work online using your favorite search engine. They both have books out. Paula’s is: Understanding Suicide and Stacey’s is: Helping the Suicidal Person.
Paula invited Stacey and I onto her podcast (which is also a video production). We all sat in separate rooms in three different states (Oregon, Colorado, and Montana) and talked about, “How on earth” it could be that pandemic-related mental health stress and distress is up (the research says so), and yet suicide rates in 2020 dipped, for the first time in two decades? What a great question!
Between the three of us, we had many answers. That’s good, because death by suicide is always influenced by many factors (in the scientific world, we like to say that suicide is multi-determined). Our answers are speculative, but I think it’s good to be speculative, as long as you admit to the fact that you’re being speculative.
The most fascinating of many fascinating explanations for the recent reduction in suicide rates was our “in real time” discovery that the pandemic relief checks went out in April of 2020. That was important because, year-after-year, the CDC reports that April is nearly ALWAYS the month with the highest suicide rates and in 2020, it was the LOWEST. Why is April always linked to high suicide rates? No one knows for sure, but Paula, Stacey, and I talk about potential explanations for that too. As T. S. Eliot wrote:
“April is the cruelest month, breeding lilacs out of the dead land, mixing memory and desire, stirring dull roots with spring rain.”
If you’re interested in suicide-related phenomena—not everyone is—you should listen or watch Paula’s “Understand Suicide” podcast. You can watch any of the episodes for great info, but for our episode, here are the links.